VACCINE PREVENTABLE DISEASE SECTION
Pertussis Treatment and Prophylaxis
Antimicrobials are recommended for both treatment of pertussis cases and prophylaxis of case contacts. The same
regimen is used for both.
▪
▪
Cases should be treated as early in the course of illness as possible. Because pertussis is toxin-mediated, symptoms
do not necessarily resolve with treatment. If treatment is started early in the course of illness (during the catarrhal
stage), symptoms may be lessened. Cases will become noninfectious after completing 5 days of antibiotic treatment.
Treatment initiated more than 3 weeks after onset of illness is of no value because viable organisms are no longer
present.
In certain situations, close contacts of pertussis cases may be treated with antimicrobials to prevent infection.
Prophylaxis should be initiated as soon as possible within 21 days (the maximum incubation period for pertussis) of
exposure to an infectious case. Special emphasis for prophylaxis should be placed on:
▪ Household members.
▪ Persons at high risk for severe pertussis: Infants <12 months, pregnant women (especially those in the third
trimester), and those with a pre-existing condition that may be exacerbated by a pertussis infection.
▪ Persons in contact with those at high risk for severe pertussis.
▪ Health care workers who have unprotected exposure and are likely to expose those at high risk for severe
pertussis.
▪ Other situations as appropriate in limited settings and recommended by public health.
Antibiotic treatment and prophylaxis
Note: All three macrolides are considered equally appropriate as first line agents for the treatment or prophylaxis of
pertussis for persons 6 months of age and older. See specifics for infants <6 months.
Drug
Infant
(<6 months of age)
Azithromycin1,4
1-5 months: 10 mg/kg/day orally
(3-day course not yet approved daily for 5 days
for treatment of pertussis.)
<1 month of age: same as above
and is the preferred choice for
infants <1 month old
Child
(>6 months of age)
Adult
10 mg/kg/day orally on the
500 mg orally on the first
first day (maximum 500 mg), 5 day, 250 mg once daily on
mg/kg once daily on days 2-5 days 2-5
(maximum 250 mg/day)
Clarithromycin2,4
Not recommended for use in
pregnant women.
Not recommended for use in infants 15 mg/kg/day orally divided
<6 months of age; see child dose for into 2 doses/day for 7 days
infants >6 months of age
(maximum 1 g/day)
Erythromycin1,3,4
Estolate preparation preferred if
40-50 mg/kg/day orally
2 g/day orally divided into 4
available
divided into 4 doses/day for 14 doses/day for 14 days
1-5 months: 40-50 mg/kg/day orally days (maximum 2 g/day)
divided into 4 doses/day for 14 days
(maximum 2 g/day)
<1 month of age: same as above,
but should only be used as an
alternate drug. Drug use is
associated with elevated risk of IHPS
TrimethoprimSulfamethoxazole2,4
For those not able to tolerate
macrolides.
Not recommended for use in
pregnant or nursing women.
Not recommended for use in
children <2 months of age; see child
dose for infants
>2 months of age
500 mg twice daily for 7
days
8 mg TMP/40 mg SMX/kg/day 320 mg TMP/1600 mg SMX
orally divided into 2 doses/day per day orally divided into 2
for 14 days (maximum 320mg doses/day for 14 days
TMP/1600mg SMX/day)
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PERTUSSIS TREATMENT AND PROPHYLAXIS
Footnotes
1
FDA Pregnancy Category B drug
2
FDA Pregnancy Category C drug
3
Some authorities prefer the estolate preparation for children but recommend avoiding its use in adults and pregnant
women.
4
Source: Centers for Disease and Control .Recommended Antimicrobial Agents for the Treatment and Postexposure
Prophylaxis of Pertussis. Centers for Disease Control and Prevention: Atlanta, GA, 2005.
www.cdc.gov/mmwr/preview/mmwrhtml/rr5414a1.htm
Vaccine-Preventable Disease Section
PO Box 64975, St. Paul, MN 55164-0975
651-201-5414 or 1-800-676-5414
www.health.state.mn.us/pertussis
To obtain this information in a different format, call: 651-201-5414.
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